Provider Demographics
NPI:1154085199
Name:UTTER, JEFFRY KEITH (LCDC)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:KEITH
Last Name:UTTER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5513
Mailing Address - Country:US
Mailing Address - Phone:325-656-3722
Mailing Address - Fax:
Practice Address - Street 1:2249 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5513
Practice Address - Country:US
Practice Address - Phone:325-656-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15554101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)